Provider Demographics
NPI:1790749299
Name:MARURI, KRISHNA K
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:K
Last Name:MARURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1436
Mailing Address - Country:US
Mailing Address - Phone:973-571-2800
Mailing Address - Fax:
Practice Address - Street 1:204 GROVE AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1436
Practice Address - Country:US
Practice Address - Phone:973-571-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA419802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091433C5QMedicare ID - Type Unspecified
F36955Medicare UPIN